Salvage debulking surgery and hyperthermic intrathoracic chemotherapy for massive recurrent mesothelioma in the mediastinum

Our plain-English summary of Salvage debulking surgery and hyperthermic intrathoracic chemotherapy for massive recurrent mesothelioma in the mediastinum, by S.S. Poon, C. Alberti, M. Nardini, et al (Interactive Cardiovascular and Thoracic Surgery, 2022).

The study

• Authors: S.S. Poon, C. Alberti, M. Nardini, M. Migliore
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2022;35(1)
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mediastinal malignant pleural mesothelioma with signs of tamponade is rare. Indication for reoperation for recurrent malignant pleural mesothelioma is a controversial but viable option in selected patients. We report a case of a 68-year-old man presenting with epithelioid malignant pleural mesothelioma who underwent a total of three debulking surgeries (pleurectomy/decortication) combined with hyperthermic intrathoracic chemotherapy. Five years after the first procedure, a third urgent operation was performed for recurrence of a large mediastinal mesothelioma causing acute symptoms of pericardial constriction and tamponade. The patient was alive for eight years since the first treatment and 36 months after the second reoperation.

© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

In plain English

This was a case report of one patient. A 68-year-old Caucasian man, a former smoker with ischaemic heart disease, was diagnosed with left-sided epithelioid malignant pleural mesothelioma in March 2013. After four cycles of platinum-based chemotherapy, he had pleurectomy/decortication with hyperthermic intrathoracic chemotherapy (heated chemotherapy inside the chest, HITHOC), then radiotherapy. In 2016 a diaphragm recurrence was treated with surgery and HITHOC. In September 2018 he came to the emergency department with low blood pressure and signs of cardiac tamponade (pressure on the heart). A CT scan showed a 25-cm mass in the anterior mediastinum (front of the central chest) compressing and displacing the heart. Surgeons removed approximately 80–90% of the mass and gave HITHOC with cisplatin at 42.5 degrees Celsius for 60 minutes. He was discharged on day 12 with a Heimlich valve for a persistent air leak; the valve was removed two weeks later. He survived eight years after the first operation and 36 months after the second reoperation before he died. The authors concluded such reoperation is occasionally feasible in selected patients with encouraging outcomes. The article did not describe asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 68-year-old Caucasian man, ex-smoker, with a history of ischaemic heart disease, diagnosed with left epithelioid malignant pleural mesothelioma in March 2013. The article does not state which hospital treated him. The authors are affiliated with hospitals in the UK and Italy.
• Exposure: Not reported. The article does not describe any asbestos or fiber exposure. It describes treatment: debulking surgery (pleurectomy/decortication) combined with hyperthermic intrathoracic chemotherapy (HITHOC), plus chemotherapy and radiotherapy.
• Main results:
  • Initial treatment after diagnosis in 2013: four cycles of platinum-based chemotherapy, then minimally invasive pleurectomy/decortication with HITHOC, then postoperative radiotherapy.
  • In 2016 an isolated recurrence on the diaphragm was found and treated with surgery combined with HITHOC.
  • In September 2018 the patient had hypotension and signs of cardiac tamponade. CT showed a large 25-cm mass in the anterior mediastinum compressing and displacing the heart posteriorly. Biopsy confirmed epithelioid mesothelial malignancy.
  • At the third operation, approximately 80–90% of the mass was removed. HITHOC was given at 42.5 degrees C with intrapleural cisplatin at 120 mg/m2 for 60 minutes.
  • After three days in intensive care, the patient was discharged on day 12 with a Heimlich valve for a persistent air leak. The valve was removed two weeks later.
  • The patient had further adjuvant chemo-radiotherapy. He survived eight years after the first operation and 36 months after the second reoperation before he died.
• The authors' conclusion: The authors concluded that reoperation with debulking surgery and HITHOC for recurrent massive mediastinal malignant pleural mesothelioma is occasionally feasible in selected patients with encouraging outcomes. They suggested it may be considered for symptomatic, critically unwell patients without distant metastasis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, Intrathoracic, Chemotherapy, Mesothelioma, Mediastinum, Pleural Mesothelioma, Epithelioid, Pleurectomy/Decortication (P/D).

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